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Increased prevalence of risk factors for cardiovascular disease in long‐term survivors of acute lymphoblastic leukemia and Wilms tumor treated with radiotherapy
Author(s) -
Geenen M.M.,
Bakker P.J.M.,
Kremer L.C.M.,
Kastelein J.J.P.,
Leeuwen F.E. van
Publication year - 2010
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.22518
Subject(s) - medicine , wilms' tumor , radiation therapy , crfs , chemotherapy , odds ratio , pediatrics , diabetes mellitus , logistic regression , cancer , gastroenterology , oncology , endocrinology , conditional random field , natural language processing , computer science
Background Only a few studies have assessed cardiovascular risk factors (CRFs) in childhood cancer survivors. We determined the prevalence of CRFs in long‐term survivors of acute lymphoblastic leukemia (ALL) and Wilms tumor. Procedure Adult survivors of ALL and Wilms tumor treated with radiotherapy and chemotherapy (RT + CT) or treated with chemotherapy alone (CT) were compared with sibling controls. CRFs (hypertension, diabetes mellitus, hypercholesterolemia, obesity, renal insufficiency) and hormonal deficiencies were assessed in each participant. Multivariate logistic regression analysis was used to evaluate the association between CRFs and treatment. Results Seventy‐nine ALL, 62 Wilms tumor survivors, and 69 control subjects (mean ages 24.5, 25.9, and 26 years, respectively) were enrolled. Mean follow‐up time since cancer treatment was 20.8 years. In the Wilms RT + CT group significantly more survivors had hypertension (21.6% vs. 1.4%, P < 0.001) and renal insufficiency (8.1% vs. 0%, P = 0.016) compared to controls. There were also more patients with multiple CRFs in the Wilms RT + CT group (16.2% vs. 2.9% in controls, P = 0.019). Almost 15% of ALL RT + CT survivors had growth hormone deficiency. Hypogonadism was seen in 18.9% of survivors in the Wilms RT + CT group. We observed no significant differences between CT‐treated survivors of both malignancies and controls. The adjusted odds ratio for the occurrence of at least one CRF was 2.6 increased for survivors following abdominal radiotherapy. Treatment with CT alone was not associated with the occurrence of multiple CRFs. Conclusions Long‐term survivors of ALL and Wilms tumor have unfavorable CRFs due to previous RT not CT. Pediatr Blood Cancer. 2010;55:690–697. © 2010 Wiley‐Liss, Inc.